Right at the outset I need to
emphasise that the following account is my own personal continuing adventure.
The errors and omissions I have made in this and my approach to prostate
cancer are all my own work. Every man's experience is an intensely personal one
and each needs to discover the best way forward for himself, based on research,
beliefs, expert advice and more than a little bit of luck (not necessarily in that
order). Anyway, for what it's worth - here goes!

History Before February 2004

I was born in 3/11/44, which made me nearly 60 years old in
February 2004.

In common with many men nowadays, from September 2001 I had
been having reasonably regular health check-ups that included blood tests and
the occasional digital rectal examination (DRE) for any evidence of problems in
that area.

By the end of 2003 my GP was becoming concerned about the size
of my prostate gland, which he detected was becoming enlarged and, I think,
somewhat knobby. As can be seen from the PSA chart, my PSA was also at quite a
high level (compared with the normal level of 4) at around 8. In retrospect,
what was probably happening during this two-year period was what is called "watchful waiting".
My personal view is that it does not appear to be very productive to be watching
and waiting for things perhaps to get worse which, in my case, they certainly did!

Updated PSA chart as at 10/12/18

Having been booked in to see a local urologist, I had some
prostate biopsy samples taken and then received the news that, "Well, you do
have prostate cancer and here are your alternatives". I must admit I sat through
that appointment in a bit of a fog, trying to absorb what I was being told but
overwhelmed by the thoughts of what the consequences of the news might be.

The Gleason score for my cancer was 6, Stage 2 and the PSA at the time
was 9.3.

My options for treatment were:

Watchful waiting (not preferred as mentioned above);

Radical prostatectomy (not keen on possible incontinence,
impotence);

External beam radiotherapy (at the time a high risk of
collateral damage to adjacent organs and relatively imprecise targeting so not preferred);

Low dose rate (LDR) brachytherapy with implanted radioactive
seeds (worry about seed migration or poor location of the seeds, so not
preferred);

High dose rate (HDR) brachytherapy with temporary implanted
tubes for insertion and withdrawal of a radioactive source (fewest complications
and/or side effects so my preferred option).

I was referred to an oncologist at the Peter MacCallum Cancer
Centre in Melbourne for a further consultation as their reputation for treating
prostate cancer was highly regarded.

Treatment for Prostate Cancer

At the consultation in Melbourne in March 2004 I was offered
the opportunity to participate in a clinical trial to determine the
effectiveness of HDR brachytherapy as a monotherapy. Normally, HDR brachytherapy
is offered as a primary treatment to be followed up by external beam
radiotherapy (EBR) a short time later. In view of my beliefs about the possible
complications of EBR I was keen to be considered for the clinical trial and so
opted for this course of action.

I was admitted
at 7.15 amon
11/5/04 after fasting
from 7 pmthe
previous evening
(compulsory from midnight) and an evening enema.

After
initial formalities, I changed into a gown and was wheeled on a trolley
to the operating theatre where I had
a spinal block administered to anaesthetise me from the waist down.

An
ultrasound probe was inserted into my rectum and this was used to guide the 15
straw length, 3mm (about) diameter hollow plastic “needles” that were inserted
into my perineum. These were held in place with a plastic template that was
sutured to my body with four sutures. A catheter was inserted into my bladder.

A large
triangular wedge was placed between my knees to prevent my legs closing. It was
also stressed to me that under no circumstances was I to move so that the
needles would touch the mattress. In other words, my pelvic area was motionless
on the bed.

Following
this procedure a CT scan was taken to make sure that the needles were placed in
the correct positions.

Then I was brought to the ward
to thaw out via the Recovery Room where I found
three other patients.
I was hooked up to a saline drip (12 hours per bag) and PCA morphine (1 ml
per 1 cc). After the anaesthetic wore off I felt lower back pain
and during the afternoon and evening used five doses of morphine. These were
automatically registered on the delivery pump equipment. I also had two Panadol
and vomited liquid, probably because of my empty stomach. I was given some
anti-nausea medication via the drip.

There was
frequent checking of blood pressure, pulse and O2 saturation level.

At about
3.45 pm I was taken to the radiation theatre, still on my bed, where
I was connected to an after-loader by the 15 needle tubes that had been
implanted during the morning. The connecting tubes were hollow metal flexible
tubes with a secure fixing arrangement at each end, about 500 mm long. The
after-loader had a disc arrangement facing me with a number (maybe 25) of
positions around the edge of the front face to which the tubes were fastened.
The radioactive pellet (I think less than rice grain size) of Iridium 192 was
stored in a lead lined box and was attached to a control wire.

There was a
dummy run during which each tube was checked for a clear run. A set of square
lead plates each 1m2 were then placed alongside my bed to shield the
radiotherapists, who were housed in an adjacent room.

The actual
treatment lasted about 15 minutes, with the pellet being inserted under computer
control into each tube in turn, for a predetermined time at different positions
within the prostate gland. The duration at each position depended on the
requirement for treatment at each location. A red light was on whenever the
pellet was out of its secure storage container.

After being
checked with a Geiger counter to ensure the pellet was not still in my body I
was then returned to the ward via the Recovery Room. I could only manage soup
for dinner, through a feeder with a straw, because I could only lift my head a
small amount.

My only
exercise was to gently raise my knees so that my feet were flat on the bed and
to bend my upper body from side to side. It was vital for me to keep my pelvic
area still as the needles protruded about 70 mm from my body and they were not
to touch the mattress, otherwise their positions in the prostate could have
changed. Consequently, I was on my back for a total of 56 hours from
8 am
on Tuesday until about 4 pm
on Thursday. I spent a restless Tuesday night with many interruptions for checks
by the nursing staff while they monitored various alarms and changed saline
bags.

Breakfast
on 12/5/04 consisted of two slices of
toast with jam, fruit juice and a cup of coffee.

Twice
during the day I was gently rolled onto my side while my
back was washed and rubbed with Sorbolene to prevent stiffness and sores. This
was a welcome change from lying on my back inert, even though it lasted for only
a few minutes at a time.

Lunch was a
small pack of sandwiches and a cup of coffee.

At about
2.45 pm I was taken for my second
treatment session. This time I was more aware of what was happening and roughly
counted the time in seconds for each dose of radiation. This was when I
discovered that the treatment times varied for different needle positions. The
times varied for different needle positions between 10 seconds and 1 minute. I felt more relaxed this time,
with no back pain.

Dinner was
soup, ice cream, jelly and a cup of coffee. I deliberately refrained from eating
much because the last thing I wanted was to have a bowel movement while lying
flat on my back. My diet was deliberately set to be low residue meals. And it
wasn’t as though I was expending much energy anyway.

Once again,
sleep was difficult, with many interruptions. Eventually the night passed, with
the aid of a sleeping tablet.

The third day, 13/5/04
was uneventful, lying
on my back, talking to other patients, listening to my small radio and waiting
for 3 pm to arrive.

At
3 pm I was wheeled down to the radiation theatre for the third
and final treatment session and removal of the needles and catheter.

Along with
me also went the morphine that I was going to need prior to the removal of the
needles. The treatment lasted slightly longer this time because the radiation
source had decayed (half life of 74 days) over the three days of my treatment.

At the end
of this treatment I was advised to release a dose of morphine before the removal
of the needles. The doctor removed the four sutures holding the plastic plate in
place and then asked me to breathe in and out deeply three times and to hold my
breath on the 4th. As I reached the 3rd I felt a sudden tearing sensation as all
15 needles and the template were removed from my body. I think the ordeal would
have been worse if each of the needles had been removed separately. The catheter
was then removed and after a check that everything was OK I was wheeled back to
Recovery to wait to go back to the ward.

Once back
in the ward I sat
gingerlyon the edge of the bed before having a very welcome
shower and changing from the gown into pyjamas. It was a very pleasant feeling
to have the freedom to move as I wanted, with no restrictions. I had my first
solid meal in three days and enjoyed simply relaxing. I was given two laxative
tablets to assist with bowel movements.

I was released
from Peter MacCallum Clinic on
14/5/04 with
Ural to reduce acid in my urine and Voltaren to help the swelling to go down
where the needles had been.

I spent the
remainder of Friday then Saturday relaxing in a nearby hotel to get my body back to normal and
returned to Hobart by air on Sunday.

All this happened when I was still working as an accountant
with the Natural Heritage Trust Unit of the Tasmanian Government, having taken
two weeks sick leave for the purpose.

On returning to work in my three days per week part-time
capacity I was able to cope reasonably well with the changes to my bowel and
bladder habits that the radiotherapy had caused.

May 2004 to March 2006

During this time, as I was part of the clinical trial at Peter
MacCallum Cancer Centre, I had my PSA checked each three months and made
frequent trips to Melbourne for interviews and consultations with the oncologist
who had treated me in May 2004.

As can be seen from my PSA chart, the level dropped to 2.5 in
November 2004 and from that time started to climb somewhat erratically to about
4.4 by mid-March 2006.

The visits to Peter MacCallum Cancer Centre took on something
of a ritual for me. I would catch a Thursday early flight (6 am) from Hobart;
bus to Melbourne; walk to East Melbourne; cup of coffee and read the paper at
Peter Mac cafeteria; appointment for 15 or 20 minutes with the oncologist; walk
back to the Skybus terminal; bus to Tullamarine by 2pm and wait for the flight
back to Hobart at 5.15pm. People would say to me, "Why don't you stay for a
footy match or see the sights over a weekend?" but I wanted the visits always to
be strictly single purpose with no distractions. A bit weird, eh?

All this time my urine flow rate was never really good but at
the end of March 2006 my life changed direction again.

I was busy planting trees at our 4 ha Sandford property when I
desperately needed to urinate. I hurried in to the toilet but, no matter how
hard I tried nothing came. This was not a good sign. Acute urinary retention is
the medical term. I phoned for an urgent appointment with my GP, was seen
immediately and then referred to Calvary Hospital Accident and Emergency
Department. I drove myself and the wait to be seen seemed to be interminable,
desperately needing to urinate the whole time.
The first doctor tried to insert a No 20 catheter to relieve my pain but failed.
He then called for a urologist who managed to do the job.

The catheter was left in place and I was admitted for a
cystoscopy and possible urethrotomy to clear the stricture. This was done the
next day. When the catheter was removed in order to check my ability to urinate
I was dismayed to discover that I still could not. The result was that I had
another in-dwelling catheter (IDC) inserted and was sent home after another day with a
leg bag, to be reviewed after one month.

April 2006 to May 2008

At this next appointment the catheter was removed and I was
instructed how to perform intermittent self-catheterisation. Initially this was
to be a daily requirement, slowly becoming less frequent until after a few
months I was using a catheter once a week to ensure the urethra was kept
reasonably clear. This has worked quite well with only one or two occasions when
I have had to revert to more frequent uses of the catheter.

My problem is that the urethral stricture is too close to the
external urinary sphincter to be cut away without damaging the sphincter, thus
causing more incontinence problems.

I left work at the beginning of April 2006 to concentrate on
getting myself used to this new regime. I continued my PSA checks and visits to
Melbourne during the remainder of 2006, through 2007 and 2008.

In May 2008 the opportunity arose for me to see a visiting
urologist from Sydney for a possible urethrotomy and dilatation of the urethra
in an attempt to cure my problems without causing any additional ones.

However, the urologist was not prepared to cut away the
stricture for the very same reason that it had not been done earlier. The result
was that I was really no better off than I was before the procedure. The
dilatation did not result in any appreciable easing of my urine flows.

June 2008 to January 2009

At about this time (June 2008) I started attending a local
Prostate Cancer Support Group. It was interesting and enlightening to hear of
other men's experiences and is something I intend to continue to do in future.

At one of my visits to Peter MacCallum Cancer Centre the
oncologist expressed concern about my rising PSA which, by this time, had
reached 11 (June 2008). He considered the distinct possibility that my
radiotherapy treatment had failed to eliminate all cancer cells. Apparently, if
a patient has three consecutive rises in PSA then it is assumed that the cancer
is still present. This had occurred to me from August 2006 to June 2007 (4.2,
4.9, 5.5 and 5.7). On the other hand, there is a phenomenon called "PSA bounce"
in which a man's PSA can rise temporarily for no apparent reason (usually within
the first 12 to 18 months after radiotherapy) before settling down to a low
level. I was hoping that was happening to me but realised the likelihood was
that I still had cancer.

The oncologist wanted me to have a CT scan and a bone scan,
but not before my PSA had reached a level of 15. This was because at a lower
level (such as I was experiencing) the scans might be negative but the cancer
was not sufficiently advanced to be detected. I was not happy with this scenario
and asked to be referred to a Melbourne urologist for further advice. He also
informed me that since 2004 there had been significant improvements in
delivering the radiation compared with my treatment.

When the appointments were kept during July 2008 it was
explained to me that, because I had already been exposed to HDR radiotherapy, no
further radiation treatment could be given. Therefore, my options were: watchful
waiting (again); hormonal therapy (not a cure but a delaying tactic); high
intensity focused ultrasound (no Medicare assistance therefore $15,000 direct
cost and still considered to be somewhat experimental); or salvage radical
prostatectomy.

Although I seriously considered hormonal therapy, my view was
that if I opted for that course of action I may never have the opportunity for
surgery at a later date if the cancer were to spread outside my prostate gland,
whereas if I had surgery and it was not successful then I may still be able to
have hormonal therapy later on.

Surgery appeared to me to be my best chance of curing me of
cancer by physically removing the prostate and cancer cells. Whether it could be done or not depended on a biopsy being positive for
cancer, CT and bone scans being negative and the prostate gland being relatively
small (40cc or less I think).

My Hobart urologist informed me that nobody would undertake
the surgery in Tasmania owing to the high risk of failure and/or serious
complications;i.e. death,
colostomy bag if the bowel were to be damaged, permanent incontinence, etc.

The biopsy was taken at the end of October 2008 and proved
positive for 5% of one of the six samples taken. The scans were done and were
negative and apparently my prostate was small enough for the operation to be
considered. The urologist told me it was difficult to obtain the biopsy
samples as my prostate was hard and somewhat shrunken (I imagine like a prune).

Therefore, on 2/12/08 the
salvage radical prostatectomy
operation was performed in Melbourne
at the Cabrini Medical Centre.
Apparently, the surgeon considers he was able to cut out all the cancerous
tissue,
including lymph nodes,
but of course there could still be microscopic cancer cells present that were
not detected and
therefore
not removed.
There was no evidence the cancer had spread outside the prostate capsule.

An issue that
had been glossed over was that, because roughly 5cm of my urethra had been
excised, (the prostate gland passing through the urethra) my penis had been
reduced in length by that amount. However, the important factor was that an
attempt had been made to cure me of prostate cancer. I have learned to live with
an ornamental penis, although it would have been nice to have been offered an
inserted graft to restore me to my pre-operation condition lengthwise!

I returned to
Tasmaniaon 6/12/08 with my
son, who had travelled over to help me, with a No 20
in-dwelling catheter. This remained in place until 22/12/08 when it was removed
following a successful cystogram under x-ray examination that confirmed there
were no leaks in my repaired urethra.

Problems
occurred almost immediately, however, when my urethra closed several times
during the following two days, stopping any urine flow except when I inserted a
No 16 catheter. Doing this caused quite a deal of pain when I pushed the
catheter into my urethra, without the benefit of any anaesthetic.

During the past two years I have had to take great care when doing this because
the walls of my urethra are thin and could be easily damaged.

On 24/12/08
in desperation I phoned the two urologists
with whom I have current referrals, only to be told they were closed until after
Christmas. My local GP and the community nursing service both said they would
not insert a catheter where a stricture existed so I arranged for a referral to Calvary
Hospital Accident & Emergency and had a No 16 IDC inserted into my bladder.

The situation will be reviewed by
my Hobart urologist
on 13/1/09 to determine whether I need to have the IDC for
a longer period of time,
maybe a suprapubic catheter
(SPC)
through my abdomen wall
or,
preferably,
revert to intermittent self-catheterization.

At some time in the future I may need to have a urethroplasty operation in an
attempt to repair the stricture. That remains to be seen.

The love, care and support I have received from both my wife,
Suzanne, and my son, Matthew, have been of enormous benefit and comfort to me.
Thank you to you both.

January 2009 to September 2009

Yes, the saga continues! At the urologist's appointment in
January the IDC was removed and I was able to use a No 16 catheter every few
days until my next appointment in hospital to have another urethral dilatation
in an attempt to enlarge the urethral stricture.

At this time my PSA was tested again (1.5). My urologist said
he would have liked the reading to be zero but I wasn't too disappointed at this
level. However, it did mean that there were still cancer cells present.

Between February and August (my next urologist's appointment)
I continued to self-catheterize every 2 or 3 days but the stricture was making
this more and more difficult. I had to reduce the size of the catheter from a No
16 (about 6mm) to 10 (3mm) or 12 (4mm) by August. However, I felt I was coping,
even though it seemed as if my waterworks were ruling my life most of the time.

Side Issue

Oh, I nearly forgot - in April I was on a short bush-walk on
the Meehan Range (not a National Park) with my son and dog (Topsy). We were
scrambling down a steep, loose gravel and rock fire trail when my right foot
slipped from under me. I think my dog pulled me, rather than it being any fault
whatsoever on my part!!

Anyway, my foot stopped against a rock but my body continued
on past it. I heard a crack, squealed like a stuck pig and fell onto my back
with my foot bent up under me. Matthew, who was following, said it looked
horrible. When I regained my composure and got my foot out from under me I found
I could still move my ankle, giving me some cause for optimism. I did not take
off my boot. We thought about our situation and decided Matthew could walk over
the ridge back to Mornington to get his car while I hobbled with Topsy along the 1km level fire
trail to meet him at the end of Belbins Road. Not a pleasant trip (walk,
stumble) but we got there eventually.

Back home and it was time to look at the damage. It did look
horrible so Matthew took me to Calvary Hospital Accident and Emergency, where an
x-ray confirmed what I had feared - the fibula was broken, but not displaced,
near the lower end. This resulted in a polyurethane cast for eight weeks - no
weight on the foot and an invalid once again. I must say Suzanne was wonderful
during that time because I am not the ideal patient - rather an "impatient".

Now, in September, my right ankle is virtually back to normal.
The swelling has reduced and I am anxious to get strength back into it to
continue with my bush-walking plans. In late August as a trial Matthew and I
walked from Cockle Creek to the coast and back as a test. A very enjoyable day
out even though the weather was less than ideal.

Back to the Main Event

At the August urologist's appointment he said the catheter
situation was not satisfactory and things would not improve. He had previously
talked to me about an SPC inserted directly into the lower abdomen and into
the bladder, thus bypassing the urethra entirely. It did not appeal to me but I
had to acknowledge the reality of my situation so I agreed to have the
procedure.

The operation was to have been done on 1/9/09 but it was not
proceeded with due to the possibility that my bladder had adhered to my colon
and the fact that my bladder is smaller now, only holding a maximum of about
200mls, rather than the 500mls or 600mls in the past.

The procedure was re-scheduled for 10/9/09 when the SPC was
inserted during open surgery. I am now recuperating from another operation and
wondering if I will eventually have a valve fitted at the outlet to control
urine flow or if I will continue to use a leg bag for the foreseeable future or
maybe even go back to self-catheterization.

Update on my PSA - the May reading was 3.6, as was also the
August reading. I suppose I am feeling relaxed about these results. At least it
has not gone up recently! Also, I haven't yet reached high levels such that I
will need hormonal therapy. I imagine that time will eventually come, however.

For what it is worth I have been drinking 300mls of
pomegranate juice each day since January 2009 in the belief that it might delay
the progress of my cancer.

Fingers crossed!

Update for December 2009

As can be seen from the PSA chart at the beginning of this
account, my PSA has now risen to 4.3 - maybe not a dramatic increase, but
nevertheless an increase. I am still taking 300mls of pomegranate juice daily;
who knows if there is a beneficial effect or not as I do not have a "control
group" against which to test myself. The urologist said, at the November
appointment, that he expects the PSA level to rise but does not want to start me
on hormonal therapy until the PSA reaches 10 or so. In the meantime, I try to
get on with life and am not stressing about what my PSA may be at some time in
the future.

A big test for me was how I was going to manage with a leg bag
on my latest bushwalk with my son, Matthew. In the end I decided I could cope
better with a self-made short tube with slide tap near the end to assist with
urination now that my urethra is permanently blocked. My trip report is at
Port Davey Track - December 2009 with a bit
of detail as to how I coped on that 6-day walk.

Well, we did the Precipitous Bluff trip from 8 Jan to 17 Jan
2010 (10 days with a rest day in the middle). See my report at
Precipitous Bluff from Cockle Creek - January
2010, with some comments about my catheter situation. This was a tremendous
personal physical challenge and, thanks to Matthew's patience and tolerance, it
was a memorable trip.

Since returning I have had a complete physical checkup, with
all sorts of blood tests, including PSA. For some unknown reason my PSA is now
3.4 (25/1/10). I don't think there is any point in my trying to analyse the
possible reasons - that's just what it is at the moment. However, I suppose I
must be cautiously optimistic. It will be interesting to get the urologist's
reaction at my next appointment towards the end of February 2010.

My next challenge will be to start using my Giant XTC2
mountain bike that I have set up as a touring bike with a BOB Yak trailer. I
have plans to ride down to Cockle Creek before Winter sets in but much training
to do before that happens.

Update for October 2010

Winter came. Winter went. Bike riding has taken a bit of a
back seat in my list of activities recently as we moved house in July after
putting the Sandford house on the market. It took seven months to sell and we
are now back in Lauderdale, in the same street that we left six years ago to
move to Sandford. Déjà vu all over again as they say in the classics!! We can
see our old house 100 metres along the road.

At the appointment in late February the urologist was fairly
happy with my progress, particularly how I was coping with the suprapubic
catheter (SPC). It is now just another part of my life and has become a daily routine
to take care of it. Every four weeks the catheter is changed by a nurse at the
local Community Health Centre.

My next appointment is in August 2010, by which time I will
have had another PSA test.

As we used the huts on the trip it was a bit easier for me to
look after my catheter. It meant that I did not need to crouch in a tent to
change the dressing each day, as I did on our earlier south-west trips.

My PSA test result in August (please see chart at the start of
this account) was 4.9. A bit disappointing as the February result was 3.4.
Apparently, I have a permanent urinary tract infection (UTI) that in normal
circumstances would be treated with an appropriate antibiotic. It is caused by
the foreign body (catheter) being fixed in my bladder. Unless I develop a
fever or other serious symptoms there is apparently little benefit in having any
treatment because I could develop a resistance to the antibiotic that would
render it less effective when it is really needed. The reason for mentioning the
UTI is that it is possible that it has an effect (unknown) on the PSA result. Up
or down, who knows?

The next appointment with the urologist is in February 2011.

Watch this space for developments.

Update for February 2011

OK - first things first. PSA is now 7.7 and probably will
continue to rise. When I received the results of this and other tests from
Pathology my initial thoughts, when I opened the envelope in front of my wife
and son, Matthew, were "Oh well, what did I really expect?" At least I am not
experiencing any adverse physical consequences of still having prostate cancer.
People put up with a lot worse, etc etc. [Updated chart is at the start of this
account.]

Various comments I have read on the web indicate that having a
UTI is likely to affect a PSA result (as mentioned above). The urologist, at the
appointment today (17/2/11), has told me that it is very unlikely to have
affected my result. However, he has agreed to put me on a course of antibiotics
prior to having another PSA test in a few weeks time in order to put my mind at
rest (or at least to eliminate the possibility of the link from my mind). I have
decided to give up on the pomegranate juice - it was not a particularly pleasant
drink anyway and, at $5.50 per litre every three days, was not a cheap drink.
Apart from the disappointing PSA level I am coping reasonably well with the SPC
- it's now just another part of my daily life and has not stopped me from doing
everything I want to.

As far as bushwalking is concerned - a few weeks ago
(mid-January 2011) Matthew and I walked from Waterfall Bay to Fortescue Bay.
This was a longish day walk on a magical coastal walk - no bog to hinder us and
a wonderful experience.

Plans for the near future and later include the Mount Anne
Circuit, a visit to South-West Cape, another trip to Frenchmans Cap in the hope
that we might get to see some views from the summit at last and others too
numerous to think about. Also, I still have not ridden to Cockle Creek or around
Tasmania in a single trip yet ......

Update to October 2011

After the course of antibiotics I had another PSA test on
31/3/11 - 7.5. I suppose this proves that the UTI is having a negligible effect
on my PSA readings - it was worth finding out anyway.

Medically, things have not been too rosy during the past four
months. As mentioned previously, my suprapubic catheter is changed every four
weeks at the local Community Health Centre. There was a normal catheter change
on 27/4/11 but at 2.30am on 12/5/11 I woke with the excruciating pain of needing
to urinate but not being able to, as the catheter was blocked. In desperation I
drove the 30-minutes trip to Calvary Accident and Emergency Department and
eventually had the catheter changed by the on-duty doctor.

Things settled down for a while until, at 8am on 11/6/11 the
same problem occurred again - needing to urinate but being unable to. Again I
drove to Calvary and had the catheter changed. I was beginning to wonder just
what was happening to me.

Within a week, at 12 noon on 18/6/11, the same problem arose
again but this time I went along to the local doctors' surgery and was able to
have the catheter changed there. On this occasion I asked if I could have the old
catheter checked to see what might have been the cause of the blockage and was
amazed to see the end of the catheter entirely blocked by a number of small
stones of some sort. [Since then I have read about bladder stones but at that
time I was ignorant of their existence.]

The next occasion (29/6/11) when I suspected that a blockage
was occurring I arranged for an urgent catheter change at the Community Health
Centre before my problem became serious. I brought the old catheter home and
dissected it to find out what the cause might be. The following images show how
large the stone was and that it almost completely blocked the end of the
catheter.

By this time I began to believe that the stones were caused by
the Calvid calcium supplement I had been taking on a daily basis to improve my
bone density. I needed this because when I had had my bone density checked by
x-ray about a year previously I was told that I had osteopenia (a precursor to
osteoporosis). I stopped taking the Calvid.

Following these episodes I contacted the urologist who was
handling my case and he booked me in for a day procedure of a bladder wash-out
and possibly to insert a larger diameter catheter to help reduce the incidence
of blockages. This occurred at the end of July 2011 when I was handed a plastic
jar with the stones that had been extracted from my bladder. As I had mentioned
to him just before the procedure that I was reluctant to have a larger catheter
if it could be avoided he used the same size in the replacement catheter.

Life has now returned to "normal" - with no further blockages
and back to four-weekly catheter changes. But, as I am no longer taking the
Calvid (and my bone density had returned to normal) I wonder if my bone density might be suffering as a result. At present it
is a small price to pay for the relative comfort of no bladder blockages.

My latest blood test for PSA (23/9/11) was 6.8. This was a bit
of a surprise as I had prepared myself for a modest increase in the level
(from 7.5 at last check) - to maybe 8 or 9 at least. So, what has caused the
drop, I asked myself? The only sensible (?), logical (?) explanation is that my
taking pomegranate capsules (2 x 500mg per day), combined with some exercise,
has helped to keep my cancer under control. At the appointment with the
Urologist on 3/10/11 he expressed some pleasure at the reduced result but
offered no explanation. Next appointment in six months time.

Next venture might be my long-overdue and much anticipated
bike trip down to Cockle Creek with Matthew over a six-day period at the end of
October. In the meantime I must continue my bike riding to get some bike fitness
back into my body. The only downside to bike riding is that the end of the
catheter that's in my bladder causes some irritation and so there is blood in my
urine for a day or so.

Update to April 2012

I must admit I was slightly disappointed that my PSA level was
7.4 at the latest blood test just prior to my appointment with the urologist in
April 2012. However, on the bright side, it hadn't jumped up dramatically so no
real cause for concern. Also, I have not experienced any more blocked catheter
episodes and I am, therefore, convinced in my own mind that they were caused by
my taking the calcium supplement, Calvid, and my body simply did not need the
extra calcium.

Just to be on the safe side, I have been booked in for a June
hospital appointment for another cystoscopy via the catheter site to make sure
there are no stones lurking in my bladder. Apart from that, life goes on as
"normal", meaning that I try to get on with things like bushwalking and bike
riding whenever I can. In July I am scheduled to have another bone density test
to check whether I am any closer to osteoporosis than I have been in the past.

The ride to Cockle Creek actually went ahead towards the end
of October. It was a hell of a trip - report is at
Ride to Cockle Creek. Also, one of my
other "must-do" adventures was attempted, but not quite entirely a success - our
walk out to South-West Cape ( Walk to
South-West Cape ) in early March 2012. This has really only whetted our
appetite for another trip in this remote area, mainly to do the South-West
Circuit, including completing the walk out to the Cape as well. In the meantime
I am planning more bike riding trips - the latest was a day ride to Dunalley (
Day Bike Ride to Dunalley )
with more to come as time permits. [I now do not understand how I found the time
to hold down a full-time job with so much to do in retirement !!!]

Apart from the June 2012 appointment, I expect my next
scheduled appointment with the urologist will be towards the end of the year,
possibly early December. In the meantime, life goes on.

Update to June 2012

In two months my PSA has risen from 7.4 to 7.9. I realise I
still have prostate cancer but that was a bit of a surprise. I am maintaining my
dosage of pomegranate capsules each day - maybe they help and maybe they don't.
Not having a control group makes it all a bit of a guessing game for me.

The cystoscopy and bladder wash-out that was performed on
19/6/12 resulted in there being a 1cm size bladder stone that, fortunately, was
taken out. No idea why that grew but I suppose I can expect more in the future.
On a positive note, the urologist is quite happy with my progress and does not
consider it necessary for me to have another appointment until 12 months have
elapsed, at which time I will have another bladder wash-out as a hospital day
patient.

In the meantime, I am planning another extended solo cycling
trip, taking everything with me, this time around the State in a clockwise
direction. I am planning to leave in early November and expect the trip to take
around a month to complete.

The next PSA blood test (and other blood tests) are due in
early December 2012. It will be interesting to find out how things have changed.

Update to December 2012

Wow - that wasn't what I expected! PSA up from 7.9 to 10.7.
Apart from that, I don't feel any different, which is some consolation at least.
Apparently, when my PSA reaches about 15 I may need to commence hormonal
therapy. From all accounts this will not be a particularly pleasant experience
but I now have no reason to expect that that level will not be reached, maybe
sooner than later.

The bike ride that I mentioned earlier actually eventuated but
did not turn out exactly the way I had planned. Notes about the "trip" are at
Bike Ride to Wayatinah.

In the meantime, life goes on as normal, with the next
appointment with the urologist being the bladder wash-out in June 2013.

Update to June 2013

On 4/6/13 I had a hospital day procedure for a suprapubic
cystoscopy and bladder wash-out. According to the urological surgeon there was
some debris in the bladder that needed to be removed. During the past year I
have had no problems with any blockages in my catheter so this was a
precautionary operation rather than one designed to correct my situation.

My PSA has now reached 11.5. I know it won't go down but the
surgeon told me that my cancer is not an aggressive one and it should be about
two years before my PSA reaches a level of 20, which is the level he now wants
to start hormonal therapy - not at 15 as I noted above. After that hormonal
therapy should give me another three years. That's a target to beat if ever I saw
one!!

Going back in time a bit - during March Matthew and I did a
two-week bike riding tour of Flinders Island. This was my first visit to the
Island but I hope it won't be my last. Notes about the trip are at
Bicycle Tour of Flinders
Island.

We now have plans to do a similar tour of King Island. Also, I
still have plans to ride around the State, in an anti-clockwise direction, maybe
towards the end of this year. Nothing definite yet though.

Update to December 2013

As shown in the chart at the beginning of this ramble, my PSA
has now risen to 14.0 at the latest test in December. I know I am repeating
myself, but on the bright side I still have no extra ill-effects of having
cancer but I sometimes try to imagine what is happening to me, from the inside.
Apparently, there is no point in having any scans at this stage as mutant cells
will probably not show up.

My bike-riding has had to take a back seat during the past
couple of months for three reasons:

1. During a walk up Mt Solitary with Matthew
(when we both had minor falls) my right upper arm sustained an injury
which has made it difficult to stretch the arm out (as when riding my bike). I
probably should have had physiotherapy but I think I may have left it too late
for that treatment to be effective now. Maybe time will be a great healer! My notes about
this adventure are at Day Walk to Mt Solitary.

2. My wife had an unexpected stay in
hospital for an operation that required her to be cared for at home after her
release from hospital, so curtailing any thoughts about trips away that I might
have had.

3. My son broke his arm while mountain-bike
riding a rough bush trail on Boxing Day and he needed some TLC during a recovery
period as he only has a live-in cat for company.

Update to March 2014

At the end of January 2014 I experienced a urine leakage
around the site where the catheter enters my abdomen. In all probability my
bladder was over-full and the urine had nowhere else to go. Anyway, at an urgent
appointment with the urological surgeon he suggested a slightly larger diameter
catheter might fix the problem. I now have a size 22 catheter instead of a size
20 (only a small increase in diameter but enough to stop any leakage). I wonder
where this possible repeated increase in catheter size might eventually lead. Do
they even make a size 50 catheter?

The next scheduled appointment will be my annual cystoscopy
and bladder wash-out during June 2014, to get rid of any accumulated bladder
stones.

Update to August 2014

During April 2014 Matthew and I spent 10 days on King Island.
We wanted this to be a bike touring holiday but the logistics proved to be too
difficult to arrange in the time we had allowed so this was a tour mainly using
a vehicle. Trip notes are at Visit to
King Island.

My annual cystoscopy and bladder wash-out took place in June,
as scheduled, to remove any bladder stones that had formed. On this occasion
there was some debris, rather than actual stones. The debris had not caused any
problems for me.

The only disappointing development was that my PSA had risen
to 16.3. I am not feeling any ill effects of having cancer and so far this is
just a number. I know that eventually I will need to have hormone therapy but
the longer I can delay the inevitable the happier I will be.

Matthew and I walked from Maydena to the Eagles Eyrie, at the
top of Abbotts Lookout on Sunday 18/8/14, after reading about the neglected
tourism venture in Hobart's Mercury newspaper. A very stiff walk on a broad,
cleared route beneath the power lines. Notes are at
Day Walk to Eagles Eyrie.

On 25/8/14 I decided to ride to Sorell and back (41kms) as I
had not been riding very much. I think I may have over-stressed my body because,
for two days after the ride, I experienced severe bladder spasms and blood in my
urine during 25/8. I hope this is not a sign of my body falling apart. It would
be a great pity if my bike-riding activities were to be at an end.

Our next walking adventures are a return visit to Maria Island
and a few days visiting some of the old huts in the Central Highlands - an area
that we have not visited very much to date.

Update to March 2015

In September 2014 Matthew and I visited Maria Island again (
Third Visit
to Maria Island ). This was a very pleasant trip, where we explored the
possible link from Robeys Farm across a direct route to the east coast.

Healthwise, my PSA reading had risen to 16.5 - not a dramatic
increase from 16.3 six months previously - but a rise nonetheless.

On our Tasmanian Trail walk in December 2014 (
Walking the Tasmanian Trail - Part 1 ) I experienced severe bladder spasms
while in my sleeping bag at night, probably from the extended walking exercise
carrying a heavy pack. I did not really have an answer to this, apart from
stopping walking.

In the days leading up to my regular four-weekly catheter
change in January 2015 I experienced a much reduced urine flow from the Flip-Flo
valve and suspected a build-up of deposits along the length of the catheter and
in the valve itself. On checking the internet I "discovered" that silicone
catheters have a larger internal diameter than the latex catheters I have been
using (obviously having thinner walls). I decided to mention this to the
urologist at my next appointment and he confirmed that they might help with
urine flow. He did mention, however, that they are not as flexible as latex. I
decided to give them a try.

A silicone catheter was used at the next catheter change
appointment but, within two days, I had it changed to a latex catheter. The
reason was that, not being as flexible, it protruded from my abdomen and caused
urine leakage around the entry point. I think I must drink more water in order
to keep my bladder flushed out and so help to prevent the build-up of deposits.
So far it is helping.

Apart from these problems I still manage to lead a reasonably
normal life, although I have not ridden my bike for a few months. No excuses but
I will just have to start riding again.

Update to July 2015

As charted at the beginning of this saga, my PSA has now risen
to 18.8 (as at 1 June 2015). I do not have any ill effects of my cancer as yet
but I am sure they will arise as time goes by.

When the bladder washout and suprapubic cystoscopy were done
in June 2015 there were some bladder stones but, fortunately, they had not
caused me any problems and I had not been aware that they were in my bladder.

During July (at the beginning of the Tour de France actually)
I decided to use my exercise bike during all the ad breaks in the live broadcast
over the three weeks of the race. I managed to keep a pretty good record of
doing it and have continued to use the bike during just about every evening
since then. At the same time I have been drinking my two litres of water. I
suppose it would be better spread out over the whole day but this is working for
me at the present time.

I have tentative plans to try a round Tasmania bike trip,
starting during November 2015. This exercise bike routine might help, leading up
to more actual bike riding on the local roads as the weather improves. On this
occasion I plan to start on an anti-clockwise trip, so avoiding the initial days
of continuous uphill slog that I encountered on my previous attempt in October
2012 ( Solo Bike Ride to Wayatinah
).

My next appointment with the urological surgeon is planned for
June 2016, when my now annual bladder washout and cystoscopy take place. If my
PSA has risen to about 20 by then he expects to start me on hormone therapy. I'm
not looking forward to it.

In April 2016 I had two hernias repaired, following the
diagnosis of pain in my left groin. Prior to this operation a blood test showed
that my PSA had risen to 19.6. Once again, not a dramatic increase but still
rising.

I had another PSA test on 27/5/16 that was at 21.0. This test
was done prior to having an annual bladder washout and cystoscopy in early June
2016. After the procedure the urological surgeon suggested that I should have a
Prostate Specific Membrane Antigen (PSMA) PET scan. This new scan is apparently
capable of detecting lower levels of cancer that has spread than more
traditional scans. The drawback was that the cost of the scan, $800, would not
be covered by Medicare and, therefore, also not by my health benefits fund. I
considered it to be too important not to go ahead with the scan and agreed to
it. The radioactive source for the scan was Gallium-68 (Ga68).

The result was that, while there was some cancer remaining in
the bed of the now-absent prostate gland and in a lymph node, there was no
evidence of cancer having spread to my bones. There was, however, "physiological
tracer activity" in the lacrimal and salivary glands, larynx, liver, spleen,
kidneys and small bowel. [The oncologist I saw later put my mind at rest as I
thought the cancer had spread to all those other areas, whereas this description
merely stated that the radioactive source had been detected in those areas.]

I asked whether it would be possible to have surgery to remove
the offending lymph node and whether immunotherapy might be appropriate to treat
my cancer.

The surgeon said that there might be a risk of unacceptable
complications with surgery and that lymph nodes are junctions in the whole
lymphatic system. He offered to provide a referral to the Melbourne-based
surgeon who had performed my radical prostatectomy and who could provide more
definitive advice if I wished to follow that course of action. Also, while he
stated that he was not aware of any trials or treatment in Australia by
immunotherapy for prostate cancer he would provide a referral to a Hobart-based
oncologist for a discussion about possibilities in that area.

I have a further appointment with the urological surgeon in
January 2017.

In the meantime, I am thinking about a possible bike tour of
King Island, either with or without Matthew, depending on his leave situation at
the end of 2016.

Update to September 2016

The appointments to review my cancer situation took place at
the end of August and in the first week of September. The results were that
immunotherapy is not yet available in Australia and the oncologist was not aware
of any clinical trials specifically for that form of treatment. The surgeon I
saw in Melbourne confirmed that the risks with any further surgery in the area
of the prostate bed included the possible loss of my bladder, with the result
that I would need a permanent external bag for urine collection and disposal.
Obviously, from my point of view, an unacceptable risk, considering that I am
able to cope reasonably well with the suprapubic catheter and flip-flo valve to
control my urine flow.

He did mention, however, that, given my level of fitness, it
might be appropriate to delay starting me on hormone therapy until my PSA
reached about 50 or when my PSA level doubled in three or six months. That was a
pleasant surprise but reinforced my understanding of current thinking that there
is no fixed level of PSA at which to commence hormone therapy.

When I had my PSA checked on 8/9/16 it had risen to 25, up
from 21 on 27/5/16. No adverse effects on me at this stage, so life continues
as before.

Update to January 2017

An unexpected complication occurred on 30/11/16 while Matthew
and I were riding on the Tasmanian Trail. We had arrived in New Norfolk and
booked in to the Junction Motel, near the lower roundabout.

When I was preparing to have my shower at the motelthe catheter came out of my body. In a state of shock I quickly pushed
the catheter back through the hole in my abdomen into my bladder and securely
taped it in position. Normally, the catheter is held inside my bladder by a
small balloon that is inflated with 10cc of sterile water at a four-weekly
catheter change.

I told Matthew of my predicament so we walked gingerly (at
least I did) to the New Norfolk Hospital/Community Health Centre to find a nurse
who would be able to do an urgent catheter change for me, using the spare
catheter I had with me.

The staff could not have been more helpful, changed the
catheter and provided me with some replacement spares in case of another
emergency. It was found that the balloon at the end of the catheter had burst
and the catheter was not held inside me as a result. I was advised it would be
preferable for me not to exert myself too much while riding my bike!

As we left the Community Centre I wondered what would happen
if I had another emergency while travelling on Jefferys Track or other bush
tracks to Dover.

The blood tests I had on 30/12/16 showed that my PSA has now
risen to 30. Obviously, this is going to continue to head upwards, but at the
appointment with the urological surgeon on 12/1/17 he seemed to be in no
particular hurry to start me on hormone therapy.

I intend to keep on pursuing my bike rides - next on the list
is a ride with Matthew, my son, to Smithton via Queenstown and the Western
Explorer at the end of this month or early February 2017.

Update to April 2017

Matthew and I rode from Lauderdale to Smithton in the two
weeks starting from 31/1/17. (Notes are at
Ride from Lauderdale to
Smithton.) While riding along the Lyell Highway between Derwent Bridge and
Queenstown I experienced a period of extreme stress when my catheter became
blocked. This occurred as we were descending Mt Arrowsmith in rain, with nowhere
sensible to stop. By the time
we reached the information shelter at Franklin River I was barely coherent.
Matthew helped me by getting the spare catheter and associated equipment out of
my pannier bag. When I was able to release the urine by cutting the tube that
held the internal balloon in place in my bladder and withdrawing the old
catheter, the feeling of relief was instant.

I believe the reason this situation occurred was because it
has not been possible for me to drink sufficient water while riding long
distances to adequately flush out my bladder. It is a lesson I need to learn on
future rides, otherwise I expect the same situation will occur again.

My next appointment with the urological surgeon is due in June
2017, when I expect him to perform my annual bladder washout to remove any
accumulated bladder stones and to check my bladder for any other potential
problems. At that appointment he might suggest it is time for me to start
hormonal therapy. I suppose it will need to happen sometime.

Update to June 2017

Imagine my surprise when I received the results of my June
2017 PSA test! The reading had gone from 30 in December 2016 to 26 on 2/6/17.
The urological surgeon could offer no explanation when I saw him at the bladder
washout procedure, except to say it was better than having risen. So that made
me feel happy.

There were bladder stones that he was able to remove
successfully. The next appointment is for June 2018, unless there are unexpected
adverse developments in the meantime.

Update to September 2017

At the end of June 2017 Matthew suggested we should take our
bikes, complete with all camping gear, and ride the
Munda Biddi Trail, a 1,000kms long off-road MTB track that commenced east of
Perth, WA at Mundaring and ended in Albany.

This sounded like an amazing adventure and we prepared to
leave in the first week of August 2017. In the intervening time I obtained
supplies of Vesicare (with alternatives of Oxytrol patches and Ditropan tablets) to help prevent bladder spasms that had been a problem for
me on previous multi-day rides. The Vesicare worked for me and I did not need
either of the other drugs. I took with me sufficient spares of catheters and Flip-Flo
valves to enable me to have catheters replaced at more frequent intervals than
the normal four weeks. My thinking was that, if I had the catheter changed each
two weeks, there would not be such a build-up of deposits in the catheter that
would result in a blockage. I also arranged to have a normal catheter change the
day before we were due to fly to Perth.

During our ride I had a catheter change at Collie Hospital
after two weeks and another at Albany during a visit to a local doctor after a
further two weeks. At this second catheter change a rather large stone was found
to be almost completely blocking the drainage hole at the inner end of the
catheter. It was changed not a moment too soon.

Each day of our stay in Western Australia I cleaned the
overnight drainage bag using bleach tablets dissolved in water and flushed the
fluid through the bag. This ensured that the bag remained relatively clean and
free from deposits the entire time we were away. I also made sure I cleaned the
catheter entry site in my abdomen and changed the dressing daily.

Update to May 2018

My PSA blood test on 29/11/17 showed a rise from 26 to 29. At
a subsequent visit to my GP he remarked that my PSA seemed to be stable. I
wished I could have been more of a "glass-half-full" person with that news
because I doubted if my PSA would maintain that sideways trend.

Early in May 2018 I developed a painful ache on the right side
of my back, below the shoulder blade. I thought I had probably strained a muscle
while working on the (flat) roof of our house. After 10 days of no improvement I
decided, with some encouragement from my wife, to get the ache checked out and I
was referred for a CT scan of my chest.

At the GP appointment to review the findings I was somewhat
shocked to be told that the pain I was experiencing was probably a result of the
spread of my prostate cancer to the area of my ribs at the back and to several
thoracic vertebrae. In addition, there were at least eight soft tissue density
nodules at various places in both lungs that are probably cancerous. [These were
subsequently discovered to be non-cancerous but more likely old scar tissue from
a childhood chest infection perhaps.]

Although I was unprepared for the news about the cancer spread, I knew I still had
prostate cancer that was not then being treated. Therefore, given time, the cancer
was certain to progress in some way. A PSA test on 17/5/18 revealed that my PSA had
risen to 74. Another test soon after showed a PSA level of 71.

I have been referred to an oncologist in order
to determine what might be the best course of action for me, given that I still
want to be able to continue touring Tasmania by bike (planned for November or December
2018). I believe that any further radiotherapy to the pelvic area is not an option for me, given my
high dose rate radiotherapy in 2004. My online reading has indicated that maybe a combination of
androgen deprivation therapy (ADT) and chemotherapy given together might be appropriate.
I may be able to have more radiotherapy if the spread of the cancer is not
extensive.

I think a new chapter of my life has begun.

Update to June 2018

In early June I had my annual bladder washout, after having
suffered no adverse events (such as blocked catheters) during the previous year.
However, the urological surgeon who performed the procedure must have realised
that there was a greater number of stones in my bladder than before. As a result
he recommended that I have the next bladder washout after six months, rather
than wait for a year to pass.

This image shows just how many stones were extracted from my
bladder on 7/6/18. The urological surgeon informed me that some were 2cm overall
and needed to be blasted by laser (laser lithotripsy) before they could be
removed.

Prior to my visit to the oncologist in mid-June to determine
what might be the next phase of my cancer treatment I was booked in for a PSMA
PET/CT scan (Prostate Specific Membrane Antigen Positron Emission
Tomography/Computed Tomography). Although this scan shows where prostate cancer
has spread to, the cost of AUD 600 is not covered by either Medicare or any
private health care fund. I paid.

The resulting report and images showed that the cancer had
spread to multiple areas, which meant that any further radiation therapy was out
of the question.

During discussions with the oncologist the option to have
immediate androgen deprivation therapy (ADT), combined with chemotherapy, was
suggested. I could have delayed the chemotherapy but, as I want to be able to
get fit enough for bike riding later in the year, I agreed to have the full
package immediately.

The paperwork that was provided to me included a daunting
list of possible side effects from both the hormone therapy and chemotherapy.
However, I was informed that it is rare for a man to have many of the problems
listed. Time will tell. The ADT consists of 1 x 50mg tablet per day of Cosudex
for one month and a three-monthly subcutaneous injection of a capsule of 1 x
10.8mg of Zoladex. The chemotherapy consists of a number of 21-day cycles of
Docetaxel drip injections into a vein.

The oncologist arranged some blood tests, including PSA for
22/6/18. When I received the results I was surprised and pleased to see that my
PSA had fallen to 53. She explained that this was the effect of the ADT tablets
that I had been taking for the previous two weeks.

So far, so good! After the initial doses of drugs on 28/6/18 I
have felt surprisingly lively, with none of the potentially serious side effects
that I had read about. That is, apart from a slightly flushed face I discovered
just before I attended a specialist's appointment for a knee injury.

Update to July 2018

On 1/7/18 I realised I needed more rest than usual so I
assumed this was another issue I needed to be aware of.

I had the second of six chemotherapy infusions on 19/7/18
following blood tests that were done on 16/7/18. At the oncologist's appointment
she informed me that my PSA had now fallen to 14.2. This was quite a surprise
for me - but a very welcome one indeed. I realise that this does not mean I am
on the way to a cancer cure but it certainly was better news than if the reading
had risen.

There are still no discernible side effects of this treatment
that might cause me any problems, which is a great relief. The next blood tests
are scheduled for 6/8/18, with the oncologist's appointment on 9/8/18.

Update to 9/8/18

At the appointment with the medical oncologist on 9/8/18,
after which I had the third infusion of chemotherapy, the first thing she said
to me after asking me to have a seat was: "Your PSA is now at 2.3." My
unprepared reply, right from the heart, was: "Holy Shit, is that right?" I then
apologised for the outburst. On seeing the result on the pathology report I
believed her. I suppose what this means is that the combination of chemotherapy
and hormone therapy seems to be having a positive effect, without any severe
side effects so far.

With a bit of luck I should finish the sixth, and final,
session of chemotherapy on 11/10/18 and I will be between hormone therapy
implants (three months apart) when my and Matthew's Northern/Eastern Tasmania
bike trip is scheduled for the end of October and through to the middle of
November 2018. In the meantime I am using my exercise bike, rowing machine and
shortish (up to about 50kms) bike rides to help to keep a bit fitter than I otherwise would be.

It will be interesting to see where my PSA is at the next
appointment on 30/8/18. So far, so good!

Update to 30/8/18

Following a series of blood tests done on 27/8/18 I was
pleasantly surprised (not shocked this time) to learn that my PSA had further
reduced to an all-time low of 1.0. In addition, the reading for ALP
(Alkaline phosphatase) had reduced from 143 to a within-range
reading of 90. The reference range is 35-110. ALP is an enzyme found in several
tissues throughout the body. Elevated levels of ALP in the blood are most
commonly caused by liver disease or bone disorders. The medical oncologist
explained that, for me, this was an indication of reduced activity of prostate
cancer in my bones. Obviously, good news.

So far, I have had minimal side effects from
this treatment. The most concerning is that my hands have become very dry, with
painful cracks opening up in a dozen places on both hands. I am now using hand
cream and rubber gloves more often than I had in the past, in the hope that this
issue will clear up quickly.

Update to 20/9/18

The improvements have continued, as reflected
in my blood test results from 17/9/18. My PSA level has now reduced to 0.6 and
may even go to a lower level in future blood tests. Obviously, I was very happy
with that. In addition, the ALP level that I mentioned above has now fallen even
further, this time to 72. Apparently, this is further evidence of reduced cancer
activity in my bones.

The problem that I was experiencing with cuts
on my fingers has now virtually gone, following a determined effort to take
better care of my hands.

At the appointment with the medical
oncologist on 20/9/18 I explained that my eyes had been watering - if they were
tears they would have been tears of joy! - but apparently this is one of the
side effects of chemotherapy and should diminish after I have finished that
treatment in three weeks time.

Meanwhile I am trying to keep as active as my
cancer treatment will allow, including the occasional 40 - 50kms bike ride and
daily walks to buy the morning paper. My weight has increased from normal, which
was between 81 and 82kgs to nearly 85kgs. Not dramatic but something I will need
to be careful about. Maybe I am eating more but the treatment probably plays a part in the increase.

Update to 11/10/18

At my appointment with the medical oncologist
on 11/10/18 I learnt that my PSA had reduced to 0.42 - a very encouraging
result. Also, the ALP level (please see description above) had dropped from 72
at the previous appointment to 66. The acceptable range for this is between 35
and 110. The current reading is a dramatic improvement from a highest level of
244 on 22/6/18. I must admit I don't really know much about this but if the
number keeps reducing I think I will remain happy about it.

I have now finished the course of six
three-weekly chemotherapy infusions and will now continue on with the
three-monthly pellet implants of the hormone treatment. So far I feel OK,
especially considering that I could have been suffering from multiple side
effects during the past 18 weeks.

It is now my intention to concentrate on
Matthew's and my upcoming bike tour of Northern and Eastern Tasmania, starting
from Smithton on 26/10/18. I am approaching this with some mild trepidation as I
have not been able to devote as much time to riding and improving my fitness as
I would have wanted to. However, our philosophy is that we will try to ease into
the riding task and improve our fitness as we go.

Update to 13/12/18

Since my previous update our bike ride has actually happened.
Notes on this trip are still being prepared but in time I will link to the
report. Very tough going for me, although Matthew seemed to take it all in his
stride and showed great patience with my slower pace throughout the 14 days we
were riding. No issues with my SPC but I arranged to have the catheter changed
at St Helens Hospital as a precaution while we were there on a rest day.

I have recently had two PSA blood tests; results were 0.17 on
26/11/18 and 0.14 on 10/12/18. I am very encouraged by these very low readings
and hope that the ADT drugs are having some positive effects.

The first blood test was in preparation for a bladder washout
on 7/12/18, at which the urological surgeon apparently found no bladder stones,
only some debris. As a result he has scheduled the next appointment for one year
rather than in the next six months.

The second blood test was done a few days prior to my
appointment with the medical oncologist. She was pleased with this result and
said that I seemed to be coping very well with the ongoing hormone therapy.
After this appointment a new pellet implant was inserted into my abdomen - an
ongoing three-monthly procedure.

I will continue to post updates to this account as and when they occur. If
you have made it through this far, congratulations on your patience with my
commentary.

It continues to be a great comfort to have the love and
understanding of my wife, Suzanne, and my son, Matthew over the past 14½ years.

I hope that the above might assist other men when
considering their options, or at least help to make them and their loved ones better informed about some of
the possible issues they may encounter on their journey.